Hif hydroxylase inhibitors

ABSTRACT

The invention provides a compound of one of the formulae (A), (B), (C), (D), (E), (F) as herein defined, or a salt thereof, for use in the treatment of a condition associated with increased or decreased HIF levels or activity, or a condition in which an increase or decrease in HIF levels or activity may be beneficial.

FIELD OF INVENTION

The present invention relates to compounds which modulate 2OG (2-oxoglutarate) dependent oxygenases, in particular prolyl hydroxylases. These may be useful as modulators of HIF (hypoxia inducible factor) alpha (HIF-α) prolyl hydroxylase.

BACKGROUND OF INVENTION

The transcription factor HIF (hypoxia inducible factor) system is a key regulator of responses to hypoxia, occupying a central position in oxygen homeostasis in a wide range of organisms. A large number of transcriptional targets have been identified, with critical roles in angiogenesis, erythropoiesis, energy metabolism, inflammation, vasomotor function, and apoptotic/proliferative responses. The system is essential for normal development, and plays a key role in pathophysiological responses to ischaemia/hypoxia. HIF is also important in cancer, in which it is commonly upregulated, and has major effects on tumour growth and angiogenesis. The HIF DNA binding complex consists of a heterodimer of α and β subunits. Regulation by oxygen occurs through hydroxylation of the α-subunits, which are rapidly destroyed by the proteasome in oxygenated cells. This involves binding of HIF-α-subunits by the von Hippel-Lindau tumour suppressor protein pVHL), with pVHL acting as the, or part of the, recognition component for a ubiquitin ligase that promotes ubiquitin dependent proteolysis through interaction with a specific sequence or sequences in HIF-α-subunits. In hypoxia, this process is suppressed, so stabilizing HIF-a and permitting transcriptional activation via the HIF α, β.

DISCLOSURE OF THE INVENTION

In our British Application No. 0118952.1 we disclose a polypeptide comprising:

-   -   (a) the amino acid sequence of SEQ ID NO: 2, 4 or 6 having HIF         hydroxylase activity;     -   (b) a variant thereof having at least 60% identity to the amino         acid sequence of SEQ ID NO: 2, 4 or 6 and having hydroxylase         activity; or     -   (c) a fragment of either thereof having HIF-α hydroxylase         activity.

Preferably, the polypeptides have prolyl hydroxylase activity and require Fe(II) for activity.

They are related by sequence to non-haem oxygenases for which crystal structures are known, e.g. proline-3-hydroxylase (Clifton et al, Eur. J. Biochem, 2001, 268, 6625-6636).

It also discloses polynucleotides which encode the polypeptides as well as expression vectors comprising the polynucleotide and antibodies capable of specifically binding the polypeptide. We also disclose assays for identifying modulators of the activity of the HIF hydroxylase as well as the use of modulators such as inhibitors of the activity of the peptides in the treatment of a condition or disease associated with altered HIF levels with respect to healthy (or normal) levels, and the treatment of conditions where an alteration in the HIF levels or activity would be beneficial.

Inhibitors of the 2-OG dependent enzyme collagen prolyl-4-hydroxylase (CPH) are well known in the art and have been previously proposed for use in the treatment of lung fibrosis, skin fibrosis (scleroderma), atherosclerosis and other conditions associated with collagen biosynthesis. Inhibitors of para-hydroxyphenylpyruvate oxygenase (a non-haem oxygenase employing ferrous iron as a co-factor) such as triketones are used as herbicides (Lee D. et al (1998) Pestic. Sci. 54(4) 377-384). We have disclosed that certain of these CPH inhibitors (and other components) also inhibit the biological (i.e. HPH) activity of an PHD polypeptide. A CPH inhibitor or modified CPH inhibitor which inhibits the biological activity of an PHD polypeptide may be used in the treatment of a condition associated with reduced or suboptimal HIF levels or activity, or a condition in which an increase in HIF levels or activity may be beneficial, for example ischaemia, wound healing, auto-, allo-, and xeno-transplantation, systemic high blood pressure, cancer, inflammatory disorders, and metabolic disorders.

Various methods and uses of modulators which inhibit, potentiate, increase or stimulate hydroxylation of HIF-α by an PHD polypeptide are disclosed. The purpose of disruption, interference with or modulation of the hydroxylation of HIF-1α by a PHD polypeptide may be to modulate cellular functions such as angiogenesis, erythropoiesis, energy metabolism, inflammation, matrix metabolism, vasomotor function, and apoptotic/proliferative responses and pathophysiological responses to ischaemia/hypoxia, all of which are mediated by HIFα as discussed above.

Compounds which modulate 2OG oxygenases, in particular CPH may be useful as modulators of HIF prolyl hydroxylase, or may be used as ‘lead’ compounds which may be modified and/or optimised to develop modulators of HIF prolyl hydroxylase, in particular selective modulators are described.

Some of these compounds generally possess the formula: R¹A*B*C*D*(R²)_(y)  (A) where the group R¹ is capable of forming an electrostatic interaction with the sidechain of the arginine residue which, together with other residues, binds the 5-carboxylate of 2-oxoglutarate during catalysis, A*B is a chain of two atoms which are, independently, carbon, oxygen, nitrogen or sulphur, which chain can be functionalised, y is 0 or 1 and C*D is a chain of two atoms which are, independently, carbon, oxygen, nitrogen, or sulphur, which chain can be functionalised, A, B, C and D being linked to one another by a single and/or double and/or triple bond such that when y is 0 or 1 at least one of the atoms of which is capable of chelating with a metal group and when y is 1 said chain is attached to R² which is capable of chelating with a metal group. Generally at least one of A, B, C and D is not carbon. Typical chains include C—N—C—C and C—O—C—C and C—C—C═O. The chain atoms can form part of a ring.

New classes of modulators of HIF prolyl hydroxylase have been found, according to the present invention. These possess the following formulae (A) to (F)

where each of R¹ and R⁵ is independently H, OH, SH, a branched or straight C₁ to C₆ alkyl chain optionally containing 1 or more eg. 2 N, S, O or P chain atoms, especially methyl, which can be functionalised, any amino acid side chain, such as alanine, phenylalanine, valine and glutamic acid, a 4 to 7 membered heterocyclic ring optionally containing 1 or 2 N, S, O or P atoms or a 5 or 6 membered aromatic ring, optionally containing 1 or 2 N, O or S atoms which may be fused to another ring or a said alkyl chain substituted by a said aromatic ring, such as aryloxy alkyl, A¹ is CH₂ or O, and each of R² and R³ is independently be H, OH, a branched or straight C₁ to C₆ alkyl chain optionally containing 1 or more eg. 2 N, S, O or P chain atoms which can be functionalised, optionally with 1, 2, 3, 4 or 5 halo substitutions, a 4 to 7 membered heterocyclic ring optionally containing 1 or 2 N, S, O or P atoms, or a 5 or 6 membered aromatic ring, optionally containing 1 or 2 N, O or S atoms which may be fused to another ring or a said alkyl chain substituted by a said aromatic ring,

wherein R² is as defined above,

is a single bond and T is CH₂ or C═O, or

is a double bond and T is CH; A² is H or —XCO₂R⁴; X is a single bond or a branched or straight C₁ to C₆ alkyl chain, optionally containing 1 or more eg. 2 N, S, O or P chain atoms and optionally substituted by eg. halo, OH, NHR² or NHCOR⁴ where R² and R⁴ are as defined above and R⁴ represents H, a branched or straight chain C₁ to C₆ alkyl group optionally containing 1 or more eg. 2 N, S, O or P chain atoms, a 4 to 7 membered heterocyclic ring, optionally containing 1 or 2 N, S, O or P atoms, or a 5 or 6 membered aromatic ring, optionally containing 1 or 2 N, O or S atoms, which may be fused to another ring, or a salt thereof,

-   -   where each X which may be the same or different is NH, NR″,         where R″ is OH, a branched or straight C₁ to C₆ alkyl chain         optionally containing 1 or more eg. 2 N, S, O or P chain atoms         which can be functionalised, or O i.e. XR¹ is typically OH or         O-alkyl having a branched or straight C₁ to C₆ alkyl chain,         especially MeO, each Y, which may be the same or different, is O         or S and each R¹, which may be the same or different, is as         defined above,         Q-(CH₂)_(m)—COOH  (D)         where m is 0 or 1, Q represents (R¹R⁶)_(x)Z where x is 0, 1 or         2, R¹ is as defined above and R⁶ is as defined for R¹, and Z is         P═O(OH)₂, B(OH)₂ or SO₃H, or a salt thereof, typically a sodium         salt, or         where each R¹, which are the same or different, is as defined         above; R¹¹ represents OH or R¹⁰ NH where R¹⁰ is HO, R¹CO or         HOOC(X)_(x) wherein R¹ is as defined above, x is 0 or 1 and X is         R¹R¹C wherein each R¹, which are the same or different, is as         defined above; or R¹⁰ is an amino acid residue H₂N(R¹R¹C)CO—         wherein each R¹, which are the same or different, is as defined         above; n is 1 or 2 and R¹² is H or straight or branched C₁ to C₆         alkyl; or a salt thereof. Typically X is CH₂ or CHOH.

Another aspect of the invention concerns analogues of 2-oxoglutarate that act as improved (relative to 2-oxoglutarate) co-substrates for the HIF hydroxylases. Such a compound is 3-fluoro 2-oxoglutarate. Assays in which this compound replaces 2-oxoglutarate demonstrate a higher level of HIF hydroxylation than observed when using 2-oxoglutarate under analogous conditions.

These analogues possess the formula:

-   -   wherein each of Z¹ and Z² is independently hydrogen, SH or an         electron withdrawing group such as halogen, preferably fluorine,         or alkoxy such as methoxy, and R¹² is as defined above, or a         salt thereof. Preferably one of Z¹ and Z² is hydrogen and the         other is fluorine (3-F-2-OG).

Accordingly the present invention provides a compound of formula (A) to (F) for use in the treatment of a condition associated with increased or decreased HIF levels or activity, or a condition in which an increase or decrease in HIF levels or activity may be beneficial, as well as the use of a compound of formula (A) to (F) in the manufacture of a medicament for the treatment of such a condition.

The said alkyl groups and chains are typically functionalised by alcohol, fluorine, thiol, a carboxylic acid, phosphonic or phosphinic acid, sulphonic acid or other chelating group, in the case of the chains typically via an alkyl group.

In the formulae described herein, a branched or straight C₁ to C₆ alkyl chain may be a methyl, ethyl, propyl, butyl, iso-butyl, tert-butyl, pentyl, neopentyl, tert-pentyl or a primary, secondary or tertiary hexyl group. Hetero atoms such as O, S, N and P may replace one or more of the carbon atoms. Preferably the alkyl groups are methyl, the preferred heterocyclic rings are pyrolidine and tetrahydropyran and the preferred aromatic rings are benzene, naphthalene and pyridine.

Typically, each of R¹ and R⁵ is independently H, OH, a branched or straight C₁ to C₆ alkyl chain optionally containing 1 or more N, S, O or P chain atoms, which can be functionalised, any amino acid side chain, a 4 to 7 membered heterocyclic ring optionally containing 1 or 2 N, S, O or P atoms or a 5 or 6 membered aromatic ring, optionally containing 1 or 2 N, O or S atoms which may be fused to another ring or a said alkyl chain substituted by a said aromatic ring.

Typically, A¹ is CH₂.

Typically, A² is —XCO₂R⁴.

Typically, R¹¹ represents R¹⁰NH where R¹⁰ is R¹CO or HOOC(X)_(x) wherein R¹ is as defined above, x is 0 or 1 and X is R¹R¹C wherein each R¹, which are the same or different, is as defined above; or R¹⁰ is an amino acid residue H₂N(R¹R¹C)CO— wherein each R¹, which are the same or different, is as defined above.

Typically, each of Z¹ and Z² is independently hydrogen or an electron withdrawing group.

Typically, in the compounds of formula (F), R¹² is H. Alternatively, R¹² may be straight or branched C₁ to C₆ alkyl.

The compounds of formula (A) are hydroxamates. Preferred compounds include those where R⁵ is aryloxyalkyl, especially oxyloxymethyl such as phenyloxymethyl or phenylalkyloxymethyl, especially benzyloxymethyl or substituted benzyloxymethyl such as p-hydroxy benzyloxymethyl and/or where R² and/or R³ is HOCH₂.

Typical compounds include N-phenoxy-acetyl-(L)-alanine-hydroxamide (Is41) and the corresponding (D) isomer (Is43) as well as the corresponding tyrosine derivatives (Is44 and 45) and L- and D-phenylglycine derivatives (Is46 and 47), along with benzo hydroxamic acid and N-phenoxyacetyl-D-phenylalanine hydroxamic acid (Is42).

These compounds can generally be prepared following the method of Walter et al., Tetrahedron 1997, 53, 7275-7290 and Biorg. Chem 1999, 27, 35-40.

The compounds of formula (B) are cyclic hydroxamates. Preferred compounds are those where X is a single bond or methyl and/or R² is H or phenylalkyl, especially benzyl and/or R⁴ is H or methyl. Typical compounds include (1-hydroxy-2,5-dioxo-pyrrolidin-3-yl) acetic acid (Is52), (1-hydroxy-2,5-dioxo-pyrrolidin-3-yl) carboxylic acid (ANU 2) and its N-benzoyloxy derivative (ANU 1) along with (1-benzyloxy-2,5-dioxo-pyrrolidin-3-yl) acetic acid (Is50) and the corresponding methyl ester (Is64), and N-hydroxy succinimide (C1). Note that Is52 (R²═H, T=C═O, X═CH₂R⁴═H) is highly active reflecting its structural analogy with 2-oxoglutarate. These compounds can be prepared using the general procedure of Schlicht et al. (U.S. Pat. No. 4,446,038).

The compounds of formula (C) are analogues of 2-oxoglutarate or oxalyl derivatives of hydroxyacetate and mercapto acetic acid. Preferred compounds include those where X is O and/or R¹ is H or methyl. Typical compounds include dimethyl oxalylglycolate (Is10) as well as its free acid (Is14) and dimethyl oxalylthioglycolate (Is11). These compounds can be prepared following Franklin et al., J. Med. Chem 1992, 35, 2652-2658 or Kwon et al., J. Am. Chem. Soc. 1989, 111, 1854-1860.

The compounds of formula (D) are carboxylic acids which possess a phosphonic, sulphonic or boronic acid group as well as salts of these. Typically R¹ and R⁶ are hydrogen. Preferred compounds include the phosphoric acids where x is 0, 1 or 2 (C3, 4 and 5, respectively) as well as disodium 3-sulpho-propionate (Is63) and its free acid, and 3-borono-propionic acid (Is62).

The compounds of formula (E) are N-acylated amino acids or polycarboxylic acids. Typical compounds are those where R¹ is H, and/or R¹² is H or ethyl. When R¹¹ represents R⁰NH the compounds are typically dipeptides such that R10 is an acyl group of a natural amino acid such as glycine. Typical preferred such compounds include Asp-Gly (C18), cyclo (Asp-Gly) (C19), beta-Asp-Gly (C20), Glu-Gly (C21) and Z-Glu-Gly (C22). Other typical compounds include those where R¹⁰ is acetyl or benzoyl such as the N-acetylated derivatives of L-aspartic acid (C6) and of L-glutamic acid (C7) i.e. R¹⁰ is acetyl and N-benzoylated derivatives of glutamic acid (C15 and Is90) i.e. R¹⁰ is benzoyl. Other typical compounds include those where R¹¹ is —NHOH such as diethyl 2-(hydroxylamino)-glutarate (Is51 being the racemic form of this compound) and those where R¹¹ is OH such as 2-hydroxyglutaric acid (Is57). When R¹¹ is HOOC(X)_(x), X is especially CH² or CHOH. The compounds are typically citric acid (C12), tricarballylic acid (C13) and succinic acid as well as the tri-methyl ester of ethane tricarboxylic acid (Is72).

The compounds of formula (F) are analogues of 2-oxoglutarate. Preferred compounds include 3-fluoro-2-oxoglutarate compounds (i.e. Z¹ is H and Z² is F) such as 3-fluoro-2-oxoglutaric acid (Is18) and the corresponding dimethyl ester (Is19).

The compounds which are acids can be present in the form of salts, such as sodium salts.

For therapeutic treatment, the compound may be used in combination with any other active substance, e.g. for anti-tumour therapy another anti-tumour compound or therapy, such as radiotherapy or chemotherapy.

Generally, the modulator is provided in an isolated and/or purified form, i.e. substantially pure. This may include being in a composition where it represents at least about 90% active ingredient, more preferably at least about 95%, more preferably at least about 98%. Any such composition may, however, include inert carrier materials or other pharmaceutically and physiologically acceptable excipients, such as those required for correct delivery, release and/or stabilisation of the active agent. As noted below, a composition according to the present invention may include in addition to a modulator compound as disclosed, one or more other molecules of therapeutic use, such as an anti-tumour agent.

In general they take the form of compositions wherein the compound is in a mixture with a pharmaceutically acceptable carrier or diluent. The carrier may be liquid, e.g. saline, ethanol, glycerol and mixtures thereof, or solid, e.g. in the form of a tablet, or in a semi-solid form such as a gel formulated as a depot formulation or in a transdermally administerable vehicle, such as a transdermal patch. The modulator compound or composition comprising it may be formulated as the coating of a coated stent.

The invention further provides a method of treatment which includes administering to a patient compound as defined above. Exemplary purposes of such treatment are discussed elsewhere herein.

The therapeutic/prophylactic purpose of such a method or use may be the modulation of the level of HIFα in a cell by modulation, e.g. disruption or interference, of the hydroxylation of HIFα, which may occur for example at proline 402, 564 or other proline residue. Hydroxylation of HIFα promotes pVHL binding which leads to ubiquitin dependent proteolysis of HIFα as described above.

The therapeutic/prophylactic purpose may be related to the treatment of a condition associated with reduced or suboptimal or increased HIF levels or activity, or conditions where an alteration in HIF levels or activity may be beneficial such as:

-   (i) ischaemic conditions, for example organ ischaemia, including     coronary, cerebrovascular and peripheral vascular insufficiency. The     therapy may be applied in two ways; following declared tissue     damage, e.g. myocardial infarction (in order to limit tissue     damage), or prophylactically to prevent or ameliorate ischaemia,     e.g. promotion of coronary collaterals in the treatment of angina. -   (ii) wound healing and organ regeneration. -   (iii) auto-, allo-, and xeno-transplantation. -   (iv) systemic blood pressure. -   (v) cancer; HIFα is commonly up-regulated in tumour cells and has     major effects on tumour growth and angiogenesis. -   (vi) inflammatory disorders. -   (vii) pulmonary arterial blood pressure, neurodegenerative disease. -   (viii) metabolic disorders, e.g. diabetes.

Modulating HIF prolyl hydroxylase activity in a person, an organ, or a group of cells may be exploited in different ways to obtain a therapeutic benefit:

(a) Non cell autonomous: The HIF system is used by cells to influence the production of substances which signal to other cells. These signals may then have effects at (i) a distant site (for example erythropoietin acts on the bone marrow) or (ii) locally (angiogenic growth factors increase the local formation of blood vessels). Manipulating non cell autonomous behaviour via altering hydroxylase activity is therefore useful in the treatment of anaemia, and local ischaemia, for example in the eye, brain, heart and limbs. Many other signals that are involved in aspects of physiological homeostasis may be, or are known to be, adjusted by HIF activation. Consequently altering HIF prolyl hydroxylase activity may be used to potentiate or initiate a helpful response for a therapeutic benefit, or to prevent or ameliorate a harmful response. For example, this approach can be used to alter appetite, or blood pressure in the systemic or pulmonary beds.

(b) Cell autonomous: the HIF system is also used by cells to regulate cellular metabolism, and decisions concerning differentiation, proliferation and apoptosis. Therefore manipulating the HIF system can be used to alter the viability and behaviour of cells. An increase in cell viability can be achieved by increasing HIF activation, for example in an ischaemic tissue. This approach can also be used in improving pancreatic beta cell viability as a way of ameliorating diabetes, or of improving the viability or function of a group or groups of neurons in Parkinson's disease, motorneurone disease or forms of dementia. In a different approach, the HIF signal can be manipulated to prevent a group of cells proliferating, or to promote its death or differentiation. For example transient activation of the HIF system in a malignant tumour can be used to provoke death of a substantial number of tumour cells.

Pharmaceutical Compositions

In various further aspects, the present invention thus provides a pharmaceutical composition, medicament, drug or other composition for such a purpose, the composition comprising one or more compounds of formulae (A) to (F), or derivatives thereof, the use of such an composition in a method of medical treatment, a method comprising administration of such a composition to a patient, e.g. for treatment (which may include preventative treatment) of a medical condition as described above, use of such an agent compound or substance in the manufacture of a composition, medicament or drug for administration for any such purpose, e.g. for treatment of a condition as described herein, and a method of making a pharmaceutical composition comprising admixing such an agent, compound or substance with a pharmaceutically acceptable excipient, vehicle or carrier, and optionally other ingredients.

The agent may be used as sole active agent or in combination with one another or with any other active substance, e.g. for anti-tumour therapy another anti-tumour compound or therapy, such as radiotherapy or chemotherapy.

Whatever the agent used in a method of medical treatment of the present invention, administration is preferably in a “prophylactically effective amount” or a “therapeutically effective amount” (as the case may be, although prophylaxis may be considered therapy), this being sufficient to show benefit to the individual. The actual amount administered, and rate and time-course of administration, will depend on the nature and severity of what is being treated. Prescription of treatment, e.g. decisions on dosage etc, is within the responsibility of general practitioners and other medical doctors.

An agent or composition may be administered alone or in combination with other treatments, either simultaneously or sequentially dependent upon the condition to be treated, e.g. as described above.

Pharmaceutical compositions according to the present invention, and for use in accordance with the present invention, may include, in addition to active ingredient, a pharmaceutically acceptable excipient, carrier, buffer, stabiliser or other materials well known to those skilled in the art. Such materials should be non-toxic and should not interfere with the efficacy of the active ingredient. The precise nature of the carrier or other material will depend on the route of administration, which may be oral, or by injection, e.g. cutaneous, subcutaneous or intravenous. The compositions will typically be sterile.

Pharmaceutical compositions for oral administration may be in tablet, capsule, powder or liquid form. A tablet may include a solid carrier such as gelatin or an adjuvant. Liquid pharmaceutical compositions generally include a liquid carrier such as water, petroleum, animal or vegetable oils, mineral oil or synthetic oil. Physiological saline solution, dextrose or other saccharide solution or glycols such as ethylene glycol, propylene glycol or polyethylene glycol may be included.

For intravenous, cutaneous or subcutaneous injection, or injection at the site of affliction, the active ingredient will be in the form of a parenterally acceptable aqueous solution which is pyrogen-free and has suitable pH, isotonicity and stability. Those of relevant skill in the art are well able to prepare suitable solutions using, for example, isotonic vehicles such as Sodium Chloride Injection, Ringer's Injection, Lactated Ringer's Injection. Preservatives, stabilisers, buffers, antioxidants and/or other additives may be included, as required.

Liposomes, particularly cationic liposomes, may be used in carrier formulations. Examples of techniques and protocols mentioned above can be found in Remington's Pharmaceutical Sciences, 16th edition, Osol, A. (ed), 1980.

The substance or composition may be administered in a localised manner to a particular site or may be delivered in a manner in which it targets particular cells or tissues, for example using intra-arterial stent based delivery.

Targeting therapies may be used to deliver the active substance more specifically to certain types of cell, by the use of targeting systems such as antibody or cell specific ligands. Targeting may be desirable for a variety of reasons, for example if the agent is unacceptably toxic, or if it would otherwise require too high a dosage, or if it would not otherwise be able to enter the target cells.

The following Examples farther illustrate the present invention.

EXAMPLE 1

In vitro screening of potential inhibitors of HIF modification was performed using a capture assay. A Ga1/HIF-1α/VP16 fusion protein expressing HIF-1α residues 549-582 was prepared by IVTT (see British Application No. 0118952.1) and used as a substrate in the assay. The unlabelled substrate was immunopurified on beads, washed, and aliquots incubated in the presence of RCC4 cell extract, with 100 μM FeCl₂ and 2 mM of the potential inhibitor. The inhibitors were either dissolved in DMSO or Tris as indicated. Controls, where no inhibitor but the equivalent amount of DMSO or Tris was added, were also performed. After washing, the beads were assayed for their ability to interact with 35-S labelled pVHL IVTT. Hydroxylation of the fusion protein by HIF hydroxylase present in the cell extract leads to the ability to capture the labelled pVHL and the amount of labelled protein bound to the fusion protein can then be measured to determine relative HIF hydroxylase activity. FIGS. 1 to 5 show HIF hydroxylase activity in the presence of a particular inhibitor relative to that seen in the absence of the inhibitor (the DMSO/Tris control). 

1. A compound of one of the formulae

where each of R¹ and R⁵ is independently H, OH, SH, a branched or straight C₁ to C₆ alkyl chain optionally containing 1 or more N, S, O or P chain atoms, which can be functionalised, any amino acid side chain, a 4 to 7 membered heterocyclic ring optionally containing 1 or 2 N, S, O or P atoms or a 5 or 6 membered aromatic ring, optionally containing 1 or 2 N, O or S atoms which may be fused to another ring or a said alkyl chain substituted by a said aromatic ring, A¹ is CH₂ or O, and each of R² and R³ is independently H, OH, a branched or straight C₁ to C₆ alkyl chain optionally containing 1 or more N, S, O or P chain atoms which can be functionalised, optionally with 1, 2, 3, 4 or 5 halo substitutions, a 4 to 7 membered heterocyclic ring optionally containing 1 or 2 N, S, O or P atoms, or a 5 or 6 membered aromatic ring, optionally containing 1 or 2 N, O or S atoms which may be fused to another ring or a said alkyl chain substituted by said aromatic ring,

wherein R² is as defined above,

is a single bond and T is CH₂ or C═O, or

is a double bond and T is CH; A² is H or —XCO₂R⁴; X is a single bond or a branched or straight C₁ to C₆ alkyl chain optionally containing 1 or more N, S, O or P chain atoms, and optionally substituted by halo, OH, OR⁴, NRR² or NHCOR⁴ where R², R³ and R⁴ are as defined above and R⁴ represents H, a branched or straight chain C₁ to C₆ alkyl group, a 4 to 7 membered heterocyclic ring, optionally containing 1 or 2 N, S, O or P atoms, or a 5 or 6 membered aromatic ring, optionally containing 1 or 2 N, O or S atoms, which may be fused to another ring,

where each X which may be the same or different is NH, NR″, where R″ is OH, a branched or straight C₁ to C₆ alkyl chain optionally containing 1 or more eg. 2 N, S, O or P chain atoms which can be functionalised, or 0, each Y, which may be the same or different, is O or S and each R¹, which may be the same or different, is as defined above, Q-(CH₂)_(m)—COOH  (D) where m is 0 or 1, Q represents (CR¹R⁶)_(x)Z where x is 0, 1 or 2, R¹ is as defined above and R⁶ is as defined for R¹ and Z is P═O(OH)₂, B(OH)₂ or SO₃H, or a salt thereof, or

where each R¹, which are the same or different, is as defined above; R¹¹ represents OH or R¹⁰NH where R¹⁰ is HO, R¹CO or HOOC(X)_(x) wherein R¹ is as defined above, x is 0 or 1 and X is R¹R¹C wherein each R¹, which are the same or different, is as defined above; or R¹⁰ is an amino acid residue H₂N(R¹R¹C)CO— wherein each R¹, which are the same or different, is as defined above; n is 1 or 2 and R¹² is H or straight or branched C₁ to C₆ alkyl; or a salt thereof,

wherein each of Z¹ and Z² is independently hydrogen, SH or an electron withdrawing group, and R¹² is as defined above, or a salt thereof for use in the treatment of a condition associated with increased or decreased HIF levels or activity, or a condition in which an increase or decrease in HIF levels or activity may be beneficial.
 2. A compound according to claim 1 which is of formula (A) where R¹ is aryloxymethyl, R² is hydrogen and R³ is hydrogen.
 3. A compound according to claim 2 wherein R¹ is phenyloxymethyl, benzyloxymethyl or p-hydroxybenzylmethyl.
 4. A compound according to claim 1 of formula (B) where X is a single bond or methyl, R² is H or phenyl alkyl and R⁴ is H or methyl.
 5. A compound according to claim 1 of formula (C) wherein X is O and R¹ is H or methyl.
 6. A compound according to claim 1 of formula (D) wherein x is 1, and R¹ and R⁶ are both hydrogen.
 7. A compound according to claim 1 of formula (E) wherein R¹ is H and R¹² is H or ethyl.
 8. A compound according to claim 7 wherein R¹¹ represents R¹⁰NH and R¹⁰ is H an acyl group of a natural amino acid, acetyl or benzoyl.
 9. A compound according to claim 7 wherein R¹¹ is HOOC(X)x.
 10. A method for the treatment of a condition associated with increased or decreased HIF levels or activity, or a condition in which an increase or decrease in HIF levels or activity may be beneficial, comprising administering the compound of claim 1 to an individual in need thereof in an amount sufficient to increase or decrease HIF levels or activity.
 11. (canceled)
 12. A pharmaceutical composition which comprises a compound as defined in claim 1 together with a pharmaceutically acceptable excipient vehicle or carrier.
 13. (canceled) 